1. Supracondylar fractures of the femur Usually affect: Usually affect: 1. Young adults from high energy trauma. 2. Elderly osteoporotic persons.

2. Mechanism of injury: Direct violence, the fracture line above the condyles and may extend between them or may be severely comminuted. The distal fragment displaced posteriorly by the gastrocnemius endangering the Popliteal artery.

3. Clinical Features The knee is deformed and swollen, movements are impossible, don’t forget to examine the distal pulses. X-ray: the line above the condyles and may extend between them with comminution; displacement and tilting are posterior. X-ray: the line above the condyles and may extend between them with comminution; displacement and tilting are posterior.

4. Treatment 1. Non operative: if slightly displaced and extra articular; use skeletal traction on a BOHLER FRAME for 6weeks followed by partial weight bearing.

5. 2. Operative: provide early mobilization and regain of knee flexion: Retrograde intramedullary nail. (if no intraarticular extension) Retrograde intramedullary nail. (if no intraarticular extension) 90°angled blade plate (old not frequently used now). 90°angled blade plate (old not frequently used now). Anatomical plate. Anatomical plate. Dynamic condylar screw. Intraarticular Extension Dynamic condylar screw. Intraarticular Extension followed by early partial weight bearing. followed by early partial weight bearing.

6. Complications 1. Arterial damage: Popliteal artery in danger even with minimal displacement, if happen need exploration and repair. 2. Joint stiffness: If intraarticular and exercise is not performed well. 3. Non union: rare if associated with knee stiffness treatment is difficult( Fixation and bone grafting).

7. Fracture Femoral Condyles One or both condyles may break and may be associated with supracondylar fractures. One or both condyles may break and may be associated with supracondylar fractures. Clinical features: pain, swelling, deformity, doughy feeling from hemarthroses; examine the distal pulses. Clinical features: pain, swelling, deformity, doughy feeling from hemarthroses; examine the distal pulses.

8. X-ray: one condyle may be fractured X-ray: one condyle may be fractured obliquely or both in T or Y pattern. Treatment: closed reduction and Treatment: closed reduction and internal fixation: Canulated screws if one condyle. Canulated screws if one condyle. Dynamic condylar screw or anatomical plate if bicondylar). Dynamic condylar screw or anatomical plate if bicondylar).

9. Dislocations Of The Knee Joint Usually caused by considerable violence, causing rupture of cruciate and collateral ligaments. Clinical features: severe bruises, swelling, gross deformity, exclude neurovascular injury. X-ray: shows the dislocation and possible fracture of the tibial spine (cruciate ligament avulsion).

10. Treatment: urgent reduction under GA, splintage by back slab in 15°flexion, close observation of the circulation for the next week. When swelling subside POP cast applied for 12 weeks followed by extensive physiotherapy. When swelling subside POP cast applied for 12 weeks followed by extensive physiotherapy.  Open reduction: is indicated if closed one fail due to interposition of injured ligaments; capsule and ligaments are sutured.

11. Complications 1. Popliteal artery damage is very common and need immediate repair. 2. Common peroneal N. may be injured but usually neuropraxia. 3. Joint instability: due to ligament injury, usually muscle strengthening control the joint. 4. Stiffness: due to prolonged immobilization.

12. Fracture Patella The largest sesamoid bone; function to increase the efficacy of the quadriceps muscles, protection of the knee. Its part of extensor mechanism (quadriceps tendon, patella, patellar ligament, extensor retinaculum).

13. Mechanism of injury: 1. Direct Force: fall onto the knee, blow against the dashboard of a car causing undisplaced crack or comminuted fracture with minimal injury to the extensor expansion. 2. Indirect Force: strong passive knee flexion while the quadriceps is contracting, causing transverse fracture with displacement.

14. Clinical features Pain, swelling, abrasions in front of the knee, a gap may be felt (transverse fracture). Test active knee extension, if present extensor mechanism is intact. Aspiration of the knee shows hemarthroses with fat droplets.

15. X-ray: (AP and lateral view) 1. Transverse fracture with displacement. 2. Comminuted fracture (stellate). Treatment:  Undisplaced and minimally displaced: Aspirate the hemarthroses and immobilization in a POP cylinder for 3-4 weeks.  Comminuted displaced fractures: Patellectomy otherwise it ends with Osteoarthrits. Patellectomy otherwise it ends with Osteoarthrits.

16.  Displaced transverse fracture: Open reduction and internal fixation by tension band method (two K- wires and figure of 8 flexible wire). Complications: 1. Knee stiffness. 2. Patello femoral osteoarthrits.